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Florence Findlay-White, Martin Adams, Rosie Donnelly, Neil Kennedy and Tim Dornan
Queen's University Belfast (QUB)
Introduction The Patient Advocacy for Prescribing Safety (PAPS) project was funded by an ASME Excellent Medical Education prize. Insulin therapy is a situation where patients have expertise that can increase doctors' capability, and where ignoring that expertise can worsen care. The research context was the ‘Making Insulin Treatment Safer’ (MITS) project, now renamed ‘Act Wisely (AW) – Diabetes’. This assumes that patients are participants in clinical care, whom clinicians should always involve. AW is a practical pedagogy, which helps clinicians learn to involve patients by involving patients. It is used in the basic education of medical students, foundation doctors, nurse-prescribers, and pharmacist-prescribers (termed [Student] clinicians).(1) The aim of PAPS was to involve people with diabetes in facilitating educative conversations about insulin therapy with (student) clinicians.
Methodology AW used Damschroder's Consolidated Framework for Implementation Research (2) to guide our programme, and Michie's Capability-Opportunity-Motivation-Behaviour theory (3) to guide behavioural commitments, which clinicians make during ‘case-based discussions’ (CBDs). These one-to-one reflective conversations use non-directive counselling principles to help discussants (who may be a person with diabetes, doctor, nurse, or pharmacist) ‘empower’ clinicians to act wisely. (Student) clinicians make one or more specific, measurable, achievable, realistic, and time-bound (SMART) commitments to address clinical situations wisely in future. (4)
Results The Medical School of Queen's University Belfast, Northern Ireland Medical and Dental Training Agency (Deanery equivalent), and all Health and Social Care Trusts supported the programme, whose procedures comply with their requirements. It was possible for GMC-registered practitioners to delegate CBD to PAs (like nurses and pharmacists) who provided completed forms to include in (student) clinicians' learning portfolios. Facilitating AW discussions online, rather than in person, avoided complications that would have arisen from PAs meeting trainees on NHS premises. PAPS identified no structural obstacles to service users facilitating educative discussions with medical students or foundation trainees. When last audited, 8 PAs had conducted 49 CBDs across the Region. Six PAs have now ‘graduated’ from our faculty development programme and 2 more will do so soon.
Conclusions PAPS brings patient advocacy into the mainstream of undergraduate and early postgraduate medical education. Despite us being diabetes clinicians and a service user, who are known among the clinical care and education community, our position as researchers and education developers, rather than officers in institutions, limited uptake. We offer our expertise and procedures (4) to educators elsewhere and predict that, with strong institutional advocacy, implementation might almost drive itself.
REFERENCES
1. Gillespie H, Findlay White F, Kennedy N, Dornan T. Enhancing workplace learning at the transition into practice. Lessons from a pandemic. Med Educ. 2019;2020:1186–7.
2. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implement Sci. 2009;4(50):40–55.
3. Michie S, vanStralen MM, West R, et al. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci [Internet]. 2011;6(1):42.
4. Making Insulin Treatment Safer [Internet]. 2017 [cited 2018 Jul 5]. Available from: http://www.med.qub.ac.uk/mits/
ASME/GMC Excellent Medical Education Award (CPD Category) 2019: ‘Thriving Lessons’: Optimising strategies to promote medical students' wellbeingLibby Terrieux-Taylor, Danielle Carrieri and Alice Osborne
University of Exeter
Introduction The mental health of medical students and doctors is a pressing concern in the UK and worldwide (1, 2). Its consequences are far reaching and include dropout, depression, self-harm, suicide (2), poor academic performance and patient care (3). This complex problem requires multi-level integrated approaches targeting individual ‘skills’, as well as changes at organisational, professional and cultural levels (4). In the UK, regulatory bodies and institutions such as the GMC (5) and HEE (6) have argued for the importance to start early in developing doctors' wellbeing, self-awareness, and self-care. A growing number of medical schools in the UK are introducing a wide variety of different initiatives to promote wellbeing and tackle mental ill-heath (7). However, most programme leaders and educators lack guidance and resources to develop these initiatives or to properly incorporate them within education and training programmes.
Method This project aims to address the identified gap by undertaking a realist evaluation of the delivery and impacts of the initiatives to support the health and wellbeing of the medical students at the University of Exeter, through focus groups and interviews with educators involved in the design and delivery of the wellbeing support, other educators and medical students.
Objectives of the research Make explicit the implicit theories held by staff who are involved in the design and delivery of the wellbeing aspects of the curriculum, support and initiatives in order to understand their beliefs about the different contexts, mechanisms and outcomes that may be important to promote wellbeing. Identify how or whether the wellbeing support and initiatives are functioning, in what circumstances and why (or why not). Develop evidence-based recommendations to optimise the support and initiatives aimed at medical students' wellbeing.REFERENCES
1. Lemaire JB, Wallace JE. Burnout among doctors. BMJ. 2017;358:j3360.
2. Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: A systematic review and meta-analysis. Jama. 2016;316(21):2214–36.
3. Bodenheimer T, Sinsky C. From triple to quadruple aim: Care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–6.
4. Gerada C. The wounded healer—Why we need to rethink how we support doctors. BMJ. 2015;351:h3526.
5. General Medical Council (GMC). Supporting medical students with mental health conditions [internet]. GMC. [Accessed 20 May 2021]. Available from: https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/supporting-medical-students-with-mental-health-conditions
6. Health Education England (HEE). NHS staff and learners' mental wellbeing report [internet]. HEE. [Accessed 20 May 2021]. Available from: https://www.hee.nhs.uk/our-work/mental-wellbeing-review
7. Tackett S, Wright S, Lubin R, Li J, Pan H. International study of medical school learning environments and their relationship with student well-being and empathy. Med Educ. 2017;51(3):280–9.
ASME/GMC Excellent Medical Education Award (UG Category) 2019: Interdisciplinary co-design for mental health and wellbeing: What educational value is created, for whom and why?Kathleen Leedham-Green, Wing May Kong, Jennifer Wallis, Fiorenza Shepherd and Elizabeth Muir
Imperial College London; Ro Spankie and Alastair Blyth from the University of Westminster
Introduction Psychiatric outcomes are profoundly influenced by patient experience and yet NHS mental health facilities remain relatively neglected.1 We aimed to equip learners with the knowledge, skills and attitudes to improve services from the perspective of different stakeholders. Co-design involves service users, clinicians and other stakeholders working together as partners to improve services.
We created an interdisciplinary longitudinal module involving almost 400 second year medical students and 200 mostly post-graduate architectural design students working in 64 mixed groups. Student shapers engaged appropriately consented stakeholders to create videos or written testimonies explaining their needs and critiquing a range of mental health spaces including memory clinics, neurodevelopmental playrooms, family therapy rooms and acute crisis centres. Students had guided online pre-learning on collaborative working, appropriate language in mental health, as well as orientation to the collaborative working technology. In the first online workshop students created a design brief, and in the second a design solution. Workshops were spaced to provide time for reflection and facilitated by 50 clinicians and patient advocates using Miro, Zoom and playdough. Outputs were shared with contributing NHS Mental Health Trusts via an online gallery and book.
Methodology We aimed to capture unintended as well as intended learning outcomes and the processes through which learning happened. Our approach explored experiences from within and from multiple perspectives through observation, debrief, focus groups, survey and document analysis of outputs. We used the Wenger Trayner framework2 to identify immediate, intentional, applied, realised and reframing value.
Results/discussion The module was described as “both humbling and empowering,” “one of the most enjoyable experiences I have had at the university” supporting social engagement during lockdown; and “possibly the most meaningful thing I have been involved in my academic career” by a facilitator. Learners described transferrable skills relating to co-design, quality improvement, creativity, collaborative working and communication with positive impacts beyond the module. Positive reframing included: collaborative approaches as productive and efficient; patient and carer perspectives as centrally important; services as potentially adaptable and holistic; and self as an agent for positive change. Modulating factors included group dynamics, engagement with pre-learning, online accessibility, and proficiency with the technology.
Conclusions Interdisciplinary learning through co-design is valued by learners, supports the acquisition of transferrable skills, and has enduring impacts on learning and practice including transformational reframing. The process is experiential requiring engagement and scaffolded support.
REFERENCES
1. Ford, M., Warning over ‘long-term neglect’ of mental health NHS estate, in Nursing Times. 2019.
2. Wenger, E., B. Trayner, and M. De Laat, Promoting and assessing value creation in communities and networks: a conceptual framework. 2011.
ASME PhD/Doctoral Grant – awarded 2017: ‘Children should be seen and (not) heard’: Disruptive dialectics in paediatric educationFrederick Speyer1*, Sayra Cristancho2†, Michael Shields1†, Graham Roberts3† and Tim Dornan1†
1Queen's University Belfast; 2Western University Ontario; 3University of Southampton
*Presenting Author
†Supervisors
The acute clinical workplace is central to both caring for patients and for training future doctors. Recent years have seen a move from a paternalistic healthcare agenda towards greater co-productive patient-centredness; a movement that is being echoed within clinical education practice. The traditional triadic model of patient-doctor-student seen within adult medicine is stretched in paediatrics by the presence of parents, adding an extra dimension. As exemplified in our earlier scoping review this quadratic relationship has hitherto been under researched. In this talk I shall outline how our methodological approach has helped gain a deeper insight into the effect this complex intersectional situation of educating within the acute paediatric clinical workplace has had upon those involved, and posit its implications for the future of patient care and medical education.
Educator Development Committee – Educator Development Award Winner 2019: Strengthening midwifery using peer to peer training and support across low-and-middle-income-countries: a unique approach to sharing midwifery skills and knowledgeHannah McCauley and Kirsty Lowe
Liverpool School of Tropical Medicine, University of Manchester
Introduction Across the globe, mothers and babies suffer from preventable illness and death; 99% of these deaths occur in low- and middle-income countries, and many of them are preventable with good quality healthcare (WHO 2015). It has been established that by implementing timely and appropriate evidence-based practices, antenatal and postnatal care can help to ensure healthy lives for mothers and babies and promote their well-being, in line with Sustainable Development Goals 3 and 5 (UNDP 2016). Chad has one of the highest maternal mortality rates in the world at 1,200 per 100,000 live births, with Togo's maternal mortality rate being 368 deaths/100,000 live births (UNICEF 2018). There is a palpable need and desire in all these countries to improve maternal health.
Methodology A 5-day competency-based training workshop was developed based on the 2016 WHO antenatal and postnatal care model, which aims to provide pregnant women with respectful, individualized, person-centred care at every contact with the health system (WHO 2016). The innovative workshop used a variety of teaching methodology including lectures, group work, practical skills sessions as well as learning and teaching aids. Midwives in Liverpool School of Tropical of Medicine alongside in-country teams have trained more than 1,000 healthcare providers in Nigeria, Togo, Ghana and Tanzania. When the training workshops were delivered in Chad, 12 Master Trainers trained in Togo led the rollout of the programme and trained 125 healthcare providers. All of the healthcare providers undertook objective structured clinical exams and multiple-choice questionnaires to test skills and knowledge increase immediately after the training.
Results Of the 125 healthcare providers who undertook the competency-based workshops in Chad 68% improved their knowledge and 87% improved their skills. The healthcare providers in Chad stated that they found the screening and counselling tools for HIV, TB, domestic violence and postnatal depression very useful and much needed in their settings as significant gaps in these services existed. They reported that having African midwives training them ensured cultural and setting specific issues were highlighted throughout the training. Healthcare providers enjoyed the multi-disciplinary training as they learnt from peers in many aspects of antenatal and postnatal care.
Conclusion The unique mix of skills and experiences from the Togolese master trainers ensured that the Chadian workshops were setting-specific. It also improved the sustainability of the project, with in-country master trainers taking ownership of the project, allowing a country-led approach. Working alongside our local partners ensured that we took important steps towards empowerment and resilience in a neglected area of sexual and reproductive healthcare, in line with the sustainable development goals (UNDP 2016).
REFERENCES
UNDP. The sustainable development goals. 2016.
UNICEF. Maternal and newborn health disparities country profiles. 2018.
WHO. (2015) The Global strategy for women's, children's and adolescents' health (2016–2030)
WHO. (2016) WHO recommendations on antenatal care for a positive pregnancy experience.
Educator Development Committee Educator Development Award Winner 2019: Teaching medical students about the place of emotions in medicine using Balint groupsNeera Gajree
University of Glasgow
Introduction The ability to identify, understand and share in the emotions of others is required to empathise, a key professional skill that the General Medical Council requires of doctors.1, 2 Although emotions are recognised as important in the development of doctors, knowing how to teach students about emotions can be a challenge and they are not given explicit attentions in most undergraduate curricula.3, 4
Balint groups aim to provide a supportive, non-judgemental forum for participants to reflect on their own and their patients' feelings. They are typically attended by doctors, but limited studies trialling medical student Balint groups have indicated that they can improve students' ability to empathise.5
I carried out a study that aimed to determine whether Balint groups helped medical students to gain a better understanding of the role of emotions in the doctor-patient relationship, and whether students believed that the group provided a valuable educational opportunity.
Methodology Voluntary 5-week Balint groups were run for clinical year medical students from the University of Glasgow on placement at University Hospital Hairmyres. The traditional Balint group format was adhered to. Participating students were asked to complete an anonymous questionnaire following the final group session.
Results/Discussion Sixteen medical students participated in the Balint groups, and they all completed the questionnaire. The majority of students agreed that the groups helped them to think about the place of emotions in patient encounters (86%), and provided a useful space to think about the doctor-patient relationship (94%). Most students agreed that participating in a Balint group was an important part of their training as a doctor (69%). Students overwhelmingly indicated that Balint groups provide an aspect of training that is not addressed elsewhere in the medical student curriculum (94%).
Students were asked to provide free-text comments about the most helpful aspects of the Balint group. The main themes that emerged were that the group enabled students to learn from shared experiences, provided a space for reflection, made students feel less isolated in their experiences and created a sense of camaraderie among them. When asked about challenging aspects of the Balint group, students identified a difficulty sharing emotional experiences, the voluntary nature of participation in the discussion and the small number of attendees.
Conclusion Balint groups can provide an innovative means of educating students about the role of emotions in the doctor-patient relationship. They are largely valued by students as providing an important component of medical education that they do not otherwise receive. The results of this pilot study highlight the value of making Balint groups more widely available to medical students or, better yet, implementing them into medical school curricula.
REFERENCES
1. Jeffrey D. Empathy, sympathy and compassion in healthcare: Is there a problem? Is there a difference? Does it matter? J R Soc Med. 2016;109(12):446–52.
2. General Medical Council. Outcomes for graduates 2018. [Internet]. 2018. [cited 2019 October 5]. Available from: https://www.gmc-uk.org/-/media/documents/dc11326-outcomes-for-graduates-2018_pdf-75040796.pdf
3. Bolier M, Doulougeri K, deVries J, Helmich E. ‘You put up a certain attitude’: A 6-year qualitative study of emotional socialisation. Med Educ. 2018;52:1041–51.
4. Brazeau C, Boyd L, Rovi S, Tesar C. A one year experience in the use of Balint groups with third year medical students. Fam Syst Health. 1998;16(4):431–6.
5. Atkinson D, Rosenstock J. A role for Balint groups in medical student training. Ann Behav Sci Med Educ. 2015;21(1):38–43.
Educator Development Committee Educator Development Award Winner 2020: Undergraduate experience of ENT teaching during the COVID-19 pandemic: A Qualitative StudyM. Walker and E. Stapleton
University of Manchester
Introduction The COVID-19 pandemic has transformed medical education worldwide, with a shift towards virtual delivery of teaching. ENT is a highly practical specialty with large amounts of patient contact. ENT has been identified as a specialty particularly at risk of exposure to COVID-19 due to aerosol-generating procedures in ward, clinic and theatre environments. Innovations in ENT teaching for medical students have therefore focussed on virtual learning, however there is little literature on how learning in ENT has been impacted by the pandemic. Our qualitative study aims to evaluate this, and to gain an understanding of the undergraduate experience of ENT placements during this extraordinary time.
Methods A retrospective survey with a qualitative focus was sent to medical students following ENT placements between March 2020 and March 2021. The survey was anonymous and non-compulsory. Data were collected using Google Forms and analysed with Dedoose software. Responses were qualitatively analysed and coded using a grounded theory approach. Iterative cycles were used to develop codes using a constant comparison technique. Emerging categories from codes were refined to identify core themes.
Results Core themes included reduced clinical experience compared with expectations, challenges to learning opportunities, and experience of different teaching methods. Students described reduced patient contact, reduced opportunities for history-taking and patient examination, and reduced exposure to practical procedures. Key challenges to learning opportunities were the risk of exposure to COVID-19 and a lack of fit-testing for appropriate PPE. Teaching during the placement received overall positive feedback; online teaching sessions elicited mixed opinions, with students expressing a preference for face-to-face teaching.
Conclusion Students on ENT placement have expectations of patient contact for learning opportunities. ENT departments should therefore ensure that patient contact and face-to-face learning opportunities are facilitated whilst maintaining safety. Students should be fit-tested for the appropriate level of PPE.
Educator Development Committee Educator Development Award Winner 2020: Learn More to Teach MoreScott Morrison
NHS Lothian/The University of Edinburgh
Introduction The medical literature has highlighted increasing concern regarding neurosurgical undergraduate education and how it is received by students. This qualitative study aimed to assess senior medical students' opinions on current neurosurgical teaching, student concerns, and curriculum improvement suggestions. This data was reviewed in the context of other studies to consider whether these issues appeared widespread or local. The plan was to learn more about what students wanted, and adapt as necessary to teach more of what students were keen to learn.
Method A narrative literature review was carried out using appropriate MeSH terms utilising PubMed, Ovid MEDLINE, and reference mining of primary articles. Subsequently a 21-question survey was produced assessing final year medical students' perceived level of understanding in neurosurgery, their issues with neurosurgical teaching, their ideas for how to change the current approach, and how their opinions on the specialty were altered by their teaching. The survey was distributed through the local medical school, and raw data collected was evaluated without statistical manipulation.
Results The narrative literature review highlighted numerous student issues with neurosurgical teaching, and issues with its delivery. Various suggestions were made for improvements, but little had been assessed objectively. In the local survey there were only 18 respondents. 72.2% felt the neurosurgical curriculum had an unsatisfactory approach. 83.4% did not feel they had a basic understanding of the most common neurosurgical procedures including indications. 88.8% saw scope to improve the curriculum, with a consensus in respondents that too little time was dedicated to neurosurgery. 77.8% felt their teaching had not prepared them for a junior doctor job in neurosurgery. Most concerning of all, 44% said their teaching made them less likely to pursue a neurosurgical career. A number of suggestions were made for how best to improve the current curriculum, with most leaning toward a complete re-structuring of the curriculum and how it is delivered.
Conclusion The majority of students felt neurosurgical teaching was inadequate, with scope for improvement, and that they were ill-prepared for a foundation doctor job in neurosurgery. The data also worryingly highlights current teaching deterring students from pursuing neurosurgery. These issues are reflected nation and worldwide. This study provides a remit to alter and improve current neurosurgical teaching on a wider scale. The follow-up discussion to change the curriculum was met with some interesting blocks due to local and national limits on teaching time and learning outcomes, which require further investigation and thought to overcome.
Educator Development Committee Education Innovation Award Winner 2019: Drawing and Building Your Way to Understanding: The Importance of Constructing Multiple Representations When Learning AnatomyErin Fillmore
Warwick University
Introduction Learning a concept through engaging with multiple representations of it, has long been recognized as a powerful way to facilitate understanding.1–5 Yet, learning through the active construction of multiple representations of a particular concept has only recently begun to receive attention, and has yet to be fully explored in medical education, and specifically anatomy. Research shows that learning is more successful when learners are active in the construction of their own understanding.6,7 Drawing and building physical models in order to learn are two methods through which a student can actively construct multiple representations of a concept. This type of active construction of understanding inherently involves cognitive processes central to deep learning, aids to foster conceptual change, and inherently encourages critical thinking and application.8 The act of drawing and building models in learning anatomy are powerful ways to make the unseen seen and the complex simple.
Methods This was a two-phase project. Phase 1 included development and implementation of a series of original drawing (‘Draw-It’) and model building (‘Do-It’) tasks for first year medical students at Warwick Medical School (2 cohorts; n = 404). Activities covered all anatomical systems and regions of the body, with particular focus on threshold topics students traditionally found challenging; for example, drawing the pericardial coverings of the heart, or constructing a model of the pelvic floor (Do-It). All Year 1 medical students participated in 25 ‘Draw-It’ and ‘Do-It’ sessions, each 30 minutes in length, integrated within their core anatomical curriculum spread across the academic year. Phase 2 involved a two-phase sequential explanatory mixed methods study exploring how first year medical students at Warwick Medical School (2 cohorts; n = 404) engaged with and perceived the impact of the integrated drawing and model building tasks in the year 1 curriculum. This phase included an end of year quantitative survey and follow-up semi-structured one-on-one interviews (2 cohorts; n = 46).
Results/Discussion Quantitative results from this study showed that 88% strongly agreed that the ‘Draw-It’ and ‘Do-It’ tasks helped them to simplify complex anatomy, 74% reported these tasks improved the way they visualised anatomy, and 86% reported that these tasks were key in showing them where their weak areas were. Qualitative results showed the majority of students felt the activities exposed their areas of misunderstanding, challenged them to visualise anatomy in a simpler way, increased their ability to remember complex subjects/concepts, and required them to draw upon material previously taught in the course, and re-create it in their own way. Many students felt the sessions positively ‘took away the mystery’ surrounding complex subject areas, made drawing an ‘approachable skill’, required them ‘to think about the same anatomy in many ways they never expected’, and encouraged them to think about the ‘why’ behind their anatomical learning.
Conclusion This study has both practical and theoretical benefit to the anatomical and medical education community. It offers a new understanding into the ways that drawing and model building activities can effectively be integrated throughout a curriculum to encourage students to develop critical thinking skills, and shows how these dynamic learning tools can be used to inspire learners to take an active role in the construction of their own understanding through multiple representations of a topic.
REFERENCES
1. Mayer RE. Designing instruction for constructivist learning. Instructional-Design Theories and Models: A New Paradigm of Instructional Theory. 1999;2:141–59.
2. Winn W. Learning from maps and diagrams. Educ Psychol Rev. 1991;3(3):211–47.
3. Schnotz W. Commentary: Towards an integrated view of learning from text and visual displays. Educ Psychol Rev. 2002;14(1):101–20.
4. Ainsworth S. DeFT: A conceptual framework for considering learning with multiple representations. Learning and Instruction. 2006;16(3):183–98.
5. Ainsworth, S. (2008). The educational value of multiple-representations when learning complex scientific concepts. In Visualization: Theory and practice in science education (pp. 191–208). Springer, Dordrecht.
6. Chi MT. Active-constructive-interactive: A conceptual framework for differentiating learning activities. Topics in Cognitive Science. 2009;1(1):73–105.
7. Ainsworth S, Prain V, Tytler R. Drawing to learn in science. Science. 2011;333(6046):1096–7.
8. Quillin K, Thomas S. Drawing-to-learn: A framework for using drawings to promote model-based reasoning in biology. CBE—Life Sciences Education. 2015;14(1):es2.
Educator Development Committee Education Innovation Award Winner 2020: History-taking in the age of COVID-19: Does the use of virtual patients improve student competence and confidence in taking medical and surgical histories?Alex Harbourne1, Nader Raafat1 and Kate Saunders1,2
1University of Oxford Medical School, John Radcliffe Hospital, Oxford; 2Department of Psychiatry, Warneford Hospital, Oxford
Background and Aim History-taking is recognised as an important competency in the General Medical Council's Outcomes for Graduates,1 for which the most effective learning strategy is experiential.2 The COVID-19 pandemic has meant fewer opportunities for students to engage in face-to-face patient encounters. Additionally, students may miss opportunities because they lack the confidence to take them. Simulation creates safe environments for accruing additional experience, which over time develops novices into experts.3 Despite randomised control trial evidence supporting the use of virtual patients to teach history-taking,4 there is currently no platform available to students that covers multiple specialities. Klark is a novel online medical education tool (www.klark-cases.com) where students take histories from virtual patients presenting with signs and symptoms which commonly feature in medical finals. We aim to investigate whether Klark can be used to complement medical student learning during the current pandemic and beyond.
Methods Participants were recruited from a single 4th-year medical student cohort who were preparing for end of year exams. Access was provided to Klark for a 4-week period and participants were asked to complete a feedback form and a virtual mock Objective Structured Clinical Examination (OSCE) history station at both the start and end of the trial period. The feedback form assessed changes in self-reported confidence in history-taking, individual learning styles and provided qualitative data about which Klark features were most helpful and/or how it could be improved. The OSCE results provided the competency measure and we triangulated this with student performance on Klark itself. We recorded the percentage questions asked by the student on Klark that were important for the diagnosis or part of the core clerking expected of a safe Foundation Year 1 doctor. Data collection and analysis are ongoing at the time of writing. This project has been reviewed by, and received ethics clearance through, the University of Oxford Central University Research Ethics Committee R75049/RE001.
Conclusions We hope to develop Klark into an evidence-based teaching tool that can be used across medical schools in the UK and internationally. Plans include patient and public involvement in developing our cases, particularly as we expand our range into more specialities, and incorporating multimedia to better simulate a full clerking. Users and tutors will have a dashboard to evaluate performance and highlight areas of strength and improvement. We also hope to develop Klark into a mobile app.
REFERENCES
1. General Medical Council. Outcomes for graduates. (2018).
2. Kolb DA. Experiential Learning: Experience as the Source of Learning and Development FT Press; 2014.
3. Maudsley G, Strivens J. Promoting professional knowledge, experiential learning and critical thinking for medical students. Med Educ. 2000;34:535–44.
4. Vash JH, Yunesian M, Shariati M, Keshvari A, Harirchi I. Virtual patients in undergraduate surgery education: A randomized controlled study. ANZ J Surg. 2007;77:54–9.
Educator Development Committee Education Innovation Award Winner 2020: Low-cost, High-fidelity 3D Printed Task TrainersKrishan Nandapalan
Newcastle University, UK
Introduction 3-dimensional printing (3DP) is a novel technology that is expanding rapidly and gaining traction in healthcare. One application of 3DP in healthcare is with medical education task trainers; models that healthcare professionals use to practice clinical procedures. (1, 2) This project aimed to investigate whether 3DP could be used to create low-cost, high-fidelity emergency cricothyroidotomy task trainers that would be educationally beneficial for doctors in training.
Methodology The method followed a design-based research approach, (3) which comprised four sequential steps that together constitute one cycle: specification, design and prototyping, testing, and evaluation. The specification step included determining the necessary features that the models required to be functional, and desirable features that could improve their fidelity. The design and prototyping step involved creating components from CT scans that could be printed with a desktop 3D printer, and selecting materials based on the desired properties, availability, and cost. For testing, the models were incorporated into an intensive care unit trainer course at Queen Elizabeth Hospital, Gateshead, UK, where doctors practised emergency cricothyroidotomy procedures on the models and then evaluated their experience by completing a standardised feedback form. Fidelity was assessed across five domains with each being ranked by the doctors on a five-point qualitative scale from ‘not realistic’ to ‘very realistic’. Educational value was assessed across four questions regarding how using the models impacted their learning.
Results and Discussion The material cost of producing one model was approximately £10.32, with an additional £0.50 per use for consumable components. Eight doctors attended the course and provided feedback in the first round of testing. Across the five domains of fidelity, 90% of responses were for the highest two ranks (realistic, very realistic). Across the four educational value questions, all eight participants indicated that the use of the model increased their understanding of and confidence with the procedure and would find it useful in future training. These results suggest that the models are realistic in terms of fidelity and provide educational benefit for the doctors using them, whilst being inexpensive to produce and maintain.
Conclusion This project explored the use of 3DP to create low-cost emergency cricothyroidotomy models of high fidelity and educational benefit. These findings indicate that the models created using 3DP were inexpensive, realistic, and educationally beneficial. Future work will focus on improving the models in response to the feedback and conducting further rounds of testing.
REFERENCES
1. Lichtenberger J, Tatum P, Gada S, Wyn M, Ho V, Liacouras P. Using 3D printing (additive manufacturing) to produce low-cost simulation models for medical training. Mil Med. 2018;183(suppl_1):73–7.
2. Byrne T, Yong S, Steinfort D. Development and assessment of a low-cost 3D-printed airway model for bronchoscopy simulation training. Journal of Bronchology & Interventional Pulmonology. 2016;23(3):251–4.
3. Wang F, Hannafin M. Design-based research and technology-enhanced learning environments. Educational Technology Research and Development. 2005;53(4):5–23.
The acute clinical workplace is central to both caring: Students' social networks are diverse, dynamic and deliberate when transitioning to clinical trainingAnique Atherley, Laura Nimmon, Pim W. Teunissen, Diana Dolmans, Iman Hegazi and Wendy Hu
Related to published manuscript: https://doi.org/10.1111/medu.14382
Introduction Transitions in medical education are dynamic, emotional and complex, but unavoidable. Social integration is notoriously difficult in clinical clerkships, especially if rotation-based.1, 2 Social integration buffers stress during intense periods3 and is one form of social support4—a ‘network-based phenomenon’5 describing any social transaction that may be helpful for the receiver in a particular situation.6 Therefore, creating and keeping supportive social relationships is crucial during transitions. We are yet to know how social relationships influence students' transition as they leave the classroom and go to a clinical training environment.7, 8 We used qualitative social network research methods to explore social relationships and social support as medical students transitioned from pre-clinical to clinical training.
Methodology This study took place in the 5-year medical program of Western Sydney University (WSU), Australia within a social constructivist paradigm.9 In addition to concepts from social network theory, we were further sensitised by theoretical constructs from landscapes of practice10—an iteration of community of practice theory.11 New clinical students interface with boundaries surrounding communities of clinical practice (CoCPs)12 as they attempt to socially integrate when transitioning in and out of undergraduate clerkships in the landscape of clinical practice. Likewise, social network research considers the location of the boundary around a network of people who are interacting. In this study, eight medical students completed a social network map during a semi-structured interview within 2 weeks of beginning clinical clerkships (T0) and then again 4 months later (T1). We asked students to indicate meaningful interactions that influenced their transition from pre-clinical to clinical training and discussed how these relationships impacted their transition. We conducted mixed-methods analysis on this data.
Results/Discussion At T0, eight participants described the influence of 128 people in their social support networks; this marginally increased to 134 at T1. Students' networks were diverse as people from within and beyond the clinical space made up participants' social networks (e.g., peers, doctors, family, nurses). Students' networks were dynamic as new relationships were created (e.g., with peers and doctors), old relationships were kept (e.g. with doctors and family) or dissolved over time (e.g., with near-peers and nurses). Students' networks were deliberately created, kept or dissolved relationships over time dependent on whether a relationship provided emotional support (e.g., they could trust them) and/or instrumental support (e.g., they provided academic guidance).
Conclusions This is the first social networks analysis paper related to transitioning students in medicine. We found that undergraduate medical students' social support networks were diverse, dynamic, and deliberate as they transitioned to clerkships. Participants created and kept relationships with those they trusted and who provided emotional and/or instrumental support and dissolved relationships who did not provide these functions.
REFERENCES
1. Atherley A, Hambleton IR, Unwin N, George C, Lashley PM, Taylor CG. Exploring the transition of undergraduate medical students into a clinical clerkship using organizational socialization theory. Perspectives on Medical Education. 2016;5:78–87.
2. Teunissen PW, Westerman M. Opportunity or threat: The ambiguity of the consequences of transitions in medical education. Med Educ. 2011;45:51–9.
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New Leaders Award Winner 2020: Dr. Me Project: Promoting Health, Empowering Children, Training Medical Students and GP Trainees to teach Self-Care for Self-Limiting Illnesses in Primary SchoolsChee Yeen Fung
Health Education England
Introduction With increasing demand on General Practice and Accident & Emergency, patient empowerment for appropriate self-care and inspiring medical careers is vital to sustaining the NHS.1,2 The Dr. Me Project, founded in 2015, is a volunteering programme which trains medical students and GP trainees to teach primary school children about self-care for common self-limiting illnesses and the appropriate use of NHS resources, whilst also inspiring medical careers.
Methods Medical student and GP trainee volunteers undergo bespoke training to deliver the Dr. Me Project in schools. Volunteers then teach 1-hour sessions to Year 5 classes. Teaching covers Sore Throat and Fever, Vomiting and Diarrhoea, and Minor and Head Injuries. Six case scenarios are asked at the beginning and end of the sessions, and the children decide whether to stay home, visit the GP or attend A&E. Responses before and after the session compared. A feedback questionnaire is also conducted to evaluate the children's confidence in self-care and interest in medical careers following the session.
Impact Since 2015, Dr. Me has reached 216 children. Overall, correct responses after teaching improved by an average 16.3%. The vomiting scenarios have improved from 48% to 69%, sore throat from 64% to 88% and minor injuries from 85% to 89%. Feedback showed 99% of children enjoyed the sessions, 95% felt more confident in self-care and 64% were more interested in becoming a doctor. Positive feedback has also been received from volunteers regarding their experience and professional development.
Discussion The results show the sessions delivered by medical student and GP trainee volunteers increase the children's confidence in self-care and interest in medical careers. Using local volunteers to deliver the sessions also provides a sustainable model for local health promotion and inspiring medical careers. Medical schools and VTS schemes could incorporate the Dr. Me Project into their programmes to supplement their curriculum and cover community engagement and teaching skills, and provide additional opportunities for professional development.
REFERENCES
1. NHS; 2019. The NHS Long Term Plan. [online at www.longtermplan.nhs.uk]
2. Self Care Forum; 2020. Save our NHS: Time for Action on Self Care. [online at www.selfcareforum.org/wp-content/uploads/2013/10/Self-Care-Forum-Mandate-FINAL-single-page.pdf]
New Leaders Award 2021: Leading the Foundation Year for Medicine: A widening participation initiativePeter Leadbetter
Edge Hill University
Introduction: The issue and initiative The ethos of the Foundation Year for Medicine (FY) at Edge Hill University is to widen access to medicine and to develop local doctors who can effectively and safely respond to the diverse health needs of the local community.
The FY recruits local students (NW) from non-traditional and underrepresented groups. This supports our ethos by providing students who aspire to study medicine the opportunity to gain insight into medicine and meet the standard academic level to progress to the medical programme. It ensures personal, professional and academic preparation for the demands of medical training. On successful completion of the Foundation Year for Medicine student's progress to Year 1 of the MBChB programme. It is also Edge Hill's first validated non-modular programme and is high profile in that the success of the medical programme is underpinned by a philosophy of widening access.
Methodology: Leadership role and solutions I led the development, validation and current delivery of the programme. The programme has many distinctive features including local community placements, “added value” activities, assessments that mirror MBChB assessments, portfolio development, and significant input from service providers and service uses/carers. A narrative overview, document analysis and student evaluations of the programme and associated “added value” initiatives will be presented.
Results & discussion: Impact of the initiative All students (n = 17) who began the FY in 2019 have successfully completed the course and are currently in 1st year of the MBChB programme. The entire second cohort of 20 students are “on track” to progress in September 2021.
Student evaluations and feedback indicated the positive impact of the programme, with overall satisfaction between 4.3 & 4.6 out of 5. Students have strongly agreed “that they feel part of a community of staff and students” and that they feel supported and equipped for the rigours of undergraduate medicine. This was supported by the external examiner feedback.
The innovative curriculum approach was also identified as an area of good practice in the annual Institutional Validation report. The provision of enrichment activities to add value to the student experience was highlighted as good practice (e.g., NHS core skills, community placements, field trips, specialist careers advise, and volunteering opportunities) that directly support the widening participation agenda.
Conclusion A key marker of success in leading the FY for Medicine is ensuring that the profile of the FY is raised locally and nationally. Recent involvement in national networks and media coverage that supports this narrative will also be highlighted to conclude the presentation.
Sir John Ellis Student Prize 2021: Conceptualising and measuring success for medical students who identify as widening participation: a preliminary scoping reviewAnna Harvey
North Cumbria Integrated Care Trust and Newcastle University
The proportion of under-represented groups within a certain population, often applied to access to post-16 education (OFFA). Access to medical degree courses is more competitive than access to most other degree programmes (Medical Schools Council, 2014), and medical degrees have traditionally been mostly populated with students from white, middle-class backgrounds (Milburn, 2012).
There is increasing recognition that merely tracking entrance to medical school does not paint the full picture of how students from diverse backgrounds navigate the university and professional environment. Attention must be given to how students from WP backgrounds progress in their careers beyond medical school. Centre to these conversations is how medics perceive and conceptualise success, and how this is measured, which is the focus of this piece of work. This work seeks to explore the definitions of success used in medical education literature, informed by a number of informal stakeholder scoping interviews with a focus on how WP students define their own success.
Methods The author conducted 20 informal telephone interviews with students from one London medical school who self-identified as WP. These interviews informed a non-systematic literature search via databases Google Scholar and PubMed to identify pieces of literature addressing success in medical students and doctors. A narrative review explored the measures used by literature and guidelines.
Results Scoping interviews revealed that participants had broad definitions of success at medical school, encompassing both exam-related successes as well as competency, safety and communication skills. Success was linked by participants not just with their own personal “achievements” but the ability these achievements gave them to serve their future patients.
Narrative review of key literature and medical education guidelines and documents found that despite medical education guidelines having a wide-reaching definition of the “success” needed to create safe, compassionate doctors during medical school, much of the literature understandably uses a narrower exam results and progression-based definition of success. Further work should explore how definitions of success in medical education literature could be made more holistic and more congruent with student perceptions of success.
Conclusion In considering how WP students perform in medical school we must consider what it means to be a successful medic; current literature understandably takes a narrow, exam-based and career-progression based view of student success, which is the easiest but arguably not the most useful method of analysis. As medicine becomes more diverse, so too must the professions' definition of what it means to be a successful medical student or doctor.
Small Grants 2019 Winner: Fostering effective academic-practitioner knowledge exchange in widening access to medicineKirsty Alexander
Research Department for Medical Education (RDME), UCL
Introduction Globally medical schools are under pressure to widen access and diversify their student cohorts. To achieve these goals, medical schools collaborate with, and often rely on, widening access (WA) practitioners to develop and implement initiatives to attract and support applicants from target groups.1 Practitioners' voices are largely excluded in the WA literature, however, and they can perceive academics as unapproachable.2,3 Academics may consider WA initiatives to lack a sufficient evidence-base and to be poorly evaluated.4 These tensions suggest that effective bidirectional routes of knowledge exchange (KE) are lacking. This project aimed to understand the effectiveness of current KE routes and explore how these could be optimised.
Methodology This pilot study involved semi-structured interviews (n = 9) with academics and practitioners working in WA to elicit their experiences and opinions of KE between the two communities: exploring challenges and opportunities. Participants included: academics researching WA to medicine; clinicians or medical school staff undertaking WA activities; and WA practitioners in centralised university WA teams. Data was analysed thematically, using template analysis.5
Findings Academics and practitioners identified common challenges to effective partnerships: time pressure and workload; restrictive funding; differing priorities; and no shared definition of WA. Different norms of hierarchy and communication styles needed to be overcome. For practitioners, communication could feel like it was not between equal parties, which led to a reluctance on the side of practitioners to share expertise if this contradicted academics' proposals. Practitioners rarely recognised their expertise as valuable to research; however increasingly embraced rigorous evaluation (sometimes assisted by academics) perceiving this as key to ensuring funding, buy-in and to keep programmes “fresh” and practitioners engaged. Academics with trusted relationships to practitioners found benefits for: recruitment; data collection; and powerful connections to target-groups, renewing their enthusiasm.
Conclusions Effective bidirectional routes of KE promote mutually beneficial outcomes, and both sides found collaborative exchanges and projects reignited their enthusiasm for WA. To reflect this value, the time required to build collaborative relationships should be built into funding applications and protected by managers. Academics should be aware of the power imbalance, encourage practitioners to see their expertise as valuable and give honest feedback on proposals.
REFERENCES
1. Medical Schools Council. A Journey to Medicine: Outreach Guidance London; 2014.
2. Stevenson J, Tooth R, Bennett A, Burke PJ. Writing together: Practitioners, academics and policy makers. Widening Participation and Lifelong Learning. 2018;20(3):7–13.
3. Hudson T, Pooley C. Support & Recognition for Widening Participation Practitioners London: Report for The Higher Education Academy & Continuum; 2006.
4. Cleland J, Dowell J, McLachlan J, Nicholson S, Patterson F. Identifying best practice in the selection of medical students: literature review and interview survey London; 2012.
5. King N. Using templates in the thematic analysis of text. In: Cassell C, Symon G, editors Essential Guide to Qualitative Methods in Organizational Research London: SAGE; 2004. p. 256–70.
Small Grants 2019 Winner: How do medical students' experiences inform their opinions of general practice and its potential as a future career choice? A realist reviewToni Robinson and Janet Lefroy
Keele University
Introduction Recruitment and retention of general pract
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